Thrombosis Update最新文献

{"title":"Hospitalizations for bleeding associated with apixaban versus rivaroxaban according to dose in Medicare beneficiaries","authors":"Luke S. Vest ,&nbsp;Seo H. Baik ,&nbsp;Fitsum Baye ,&nbsp;Kin-Wah Fung ,&nbsp;Clement J. McDonald","doi":"10.1016/j.tru.2025.100220","DOIUrl":"10.1016/j.tru.2025.100220","url":null,"abstract":"<div><h3>Introduction</h3><div>Apixaban and rivaroxaban are the most prescribed direct oral anticoagulants, and the safety of different doses in patients at high risk for bleeding is not fully defined. The objective of this study was to compare the rate of hospitalizations due to bleeding in patients prescribed apixaban versus rivaroxaban at specific doses.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of more than 1.9 million Medicare beneficiaries who filled prescriptions for apixaban or rivaroxaban from 2014 to 2020 using the Medicare Parts A, B, C and D encounter and prescription claims database. The primary outcomes measured were hospitalizations due to bleeding categorized by location (intracranial, gastrointestinal [GI], and other) and all-cause mortality.</div></div><div><h3>Results</h3><div>Among the population studied, 1,022,170 (53 %) filled a prescription for apixaban 5 mg during the study period, followed by rivaroxaban 20 mg (27 %) and rivaroxaban 10 mg (11 %). Compared to the reference group of apixaban 5 mg, combination prescriptions for rivaroxaban 15–20 mg were associated with more than twice the risk of hospitalization due to GI bleeding (hazard ratio [HR] = 2.41, 95 % confidence interval [CI]: 2.15–2.70) and other bleeding (HR = 2.42, 95 % CI: 1.92–3.05) and were associated with a 51 % higher risk of hospitalization due to intracranial bleeding (HR = 1.51, 95 % CI: 1.15–1.98). There were 88,740 (4.6 %) deaths during the study period, with a 27 % increased risk of death associated with prescriptions for apixaban 2.5 mg (HR = 1.27, 95 % CI: 1.24–1.30) and a 19 % decreased risk of death associated with prescriptions for rivaroxaban 10 mg (HR = 0.81, 95 % CI: 0.78–0.85).</div></div><div><h3>Conclusion</h3><div>Rivaroxaban doses of 15 mg and greater were associated with higher bleeding risk. This data may aid clinicians in making an informed decision when prescribing specific doses of apixaban and rivaroxaban, particularly for patients with a high risk of bleeding.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100220"},"PeriodicalIF":0.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144852853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic patients with carotid atherosclerosis present a higher coagulation state compared to healthy subjects","authors":"Laurie Josset ,&nbsp;Mathilde Mura ,&nbsp;Mathis Damon ,&nbsp;Emma de Cartier d’Yves ,&nbsp;Michèle Weiss-Gayet ,&nbsp;Anaelle Boreau ,&nbsp;Emeraude Rivoire ,&nbsp;Nellie Della-Schiava ,&nbsp;Anne Long ,&nbsp;Sandrine Horman ,&nbsp;Antoine Millon ,&nbsp;Vincent Pialoux ,&nbsp;Amandine Thomas","doi":"10.1016/j.tru.2025.100219","DOIUrl":"10.1016/j.tru.2025.100219","url":null,"abstract":"<div><h3>Background</h3><div>In pro-inflammatory conditions, such as atherosclerosis, circulating monocytes may express tissue factor (TF), increasing thromboembolic risk. Regular physical activity (PA) has been shown to modulate hemostasis by reducing fibrinogen concentration and platelet activation, though its effects on coagulation are limited.</div></div><div><h3>Objectives</h3><div>We aim to evaluate the procoagulant and proinflammatory state in asymptomatic patients with atherosclerotic carotid stenosis, compared to healthy subjects and to assess the impact of a 6-month PA intervention.</div></div><div><h3>Methods</h3><div>This study included patients with asymptomatic carotid stenosis and healthy subjects. Patients were randomized into a PA group (6-month individualized PA intervention), and a control group. Blood analyses were performed to assess monocyte phenotype and TF expression by flow cytometry, and coagulation parameters using rotative thromboelastometry.</div></div><div><h3>Results</h3><div>The expression of TF on the surface of circulating monocytes was significantly higher in patients than in healthy subjects (61.9 ± 11.7 % vs 33.7 ± 6.3 %, p &lt; 0.0001), mainly explained by a higher expression on classical monocytes (77.7 ± 9.5 vs 58.3 ± 15.8 %, p &lt; 0.001). Clotting times were lower in patients than in healthy subjects in basal (407.8 77.7 ± 144.6 s vs 615.5 ± 123.4 s p &lt; 0.0001) and proinflammatory (222.4 ± 48.2 s vs 307.8 ± 82.4 s p = 0.003) conditions. A 6-month PA intervention did not induce any modulation of the monocyte phenotype or coagulation parameters of patients with atherosclerosis.</div></div><div><h3>Conclusion</h3><div>Asymptomatic patients with carotid atherosclerosis have a higher proinflammatory and procoagulant profile, suggesting a higher thromboembolic risk. However, home-based PA intervention did not improve their profiles.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100219"},"PeriodicalIF":0.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144748937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring experiences of patients attending an outpatient thrombosis service in Canada","authors":"Gabriela Carrillo-Balam ,&nbsp;Tiffany Lee ,&nbsp;Stephanie Young","doi":"10.1016/j.tru.2025.100218","DOIUrl":"10.1016/j.tru.2025.100218","url":null,"abstract":"<div><h3>Background</h3><div>There is limited information on patients' experiences that influence their satisfaction and perception of the quality of care received at comprehensive thrombosis and anticoagulation management services. However, in order to provide patient-centred care, patients’ input is fundamental. Therefore, we aimed to explore the views and experiences of people who received care at an Adult Outpatient Thrombosis Service to identify aspects that are valued as well as areas for improvement.</div></div><div><h3>Methods</h3><div>This is an analysis of free-text data from an anonymous survey sent to all adult patients who received care from a multidisciplinary Thrombosis Service in Newfoundland and Labrador, Canada between October 2017 and May 2019. Thematic analysis was used to analyze the open-ended free text responses and identify common themes.</div></div><div><h3>Findings</h3><div>In total, 40.7 % (n = 229) of survey respondents (N = 563) provided comments to the free-text question. Respondents made more positive comments than negative comments. Four common themes were identified: feeling seen, heard, and cared for; the information received filled the gap and sometimes missed the mark; service organization and follow-up: smooth for some, frustrating for others; and, accessing care: virtual options, travel burden, and waiting.</div></div><div><h3>Conclusion</h3><div>This analysis highlights the positive effect of receiving clear information and having a respectful patient-provider relationship on patients' perceived quality of care. Conversely, the need for alternative consultation-delivery modes, such as virtual care, was identified as an area of opportunity to improve patients’ care experience.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100218"},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombin generation remains stable in frozen plasma over long-term storage","authors":"A. Carlo ,&nbsp;R. de Laat-Kremers ,&nbsp;B. de Laat ,&nbsp;M. Ninivaggi","doi":"10.1016/j.tru.2025.100216","DOIUrl":"10.1016/j.tru.2025.100216","url":null,"abstract":"<div><h3>Background</h3><div>The ST Genesia is a fully automated thrombin generation (TG) device. Measuring TG can be useful for medical purposes as it is an indicator for the bleeding or thrombotic risk of a patient. When measuring TG, it is of utmost importance to be careful with the preanalytical part as it can affect TG. One of the preanalytical steps to be cautious with, is the plasma sample storage temperature and duration.</div></div><div><h3>Methods</h3><div>Citrated blood was collected and centrifuged twice for 10 min at 2840g to obtain platelet poor plasma. Plasma samples were stored directly in the freezer either at −20 °C or at −80 °C. TG was measured with a low, intermediate and high tissue factor concentration (STG-BleedScreen, STG-ThromboScreen and STG-DrugScreen, respectively) in fresh samples and after storage at -20°C and -80°C for 1 day, 1 month, 3 months, 6 months and 12 months. The samples stored at −80 °C were also measured after 18 and 24 months.</div></div><div><h3>Results</h3><div>Freezing platelet poor plasma samples did affect the TG parameters. This observation was independent of the storage temperature and the tissue factor used for triggering TG. Interestingly, TG was not significantly affected by time in storage at −20 °C and −80 °C even up to one year or two years, respectively. Some variation was observed in the samples measured with thrombomodulin, which may have been due to the use of a reagent kit with different lot number.</div></div><div><h3>Conclusion</h3><div>Freezing plasma does affect TG independently of the storage temperature. However, once frozen, the TG does not vary significantly in time even up to one or two years for samples stored at −20 °C and −80 °C, respectively.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100216"},"PeriodicalIF":0.0,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduction in D-dimer levels after treatment with Auxora in patients with severe COVID-19 pneumonia","authors":"Peter C. Hou ,&nbsp;Joseph Miller ,&nbsp;Charles Bruen ,&nbsp;Fady Youssef ,&nbsp;Michael J. Schnaus ,&nbsp;Kathyrn Brouillette ,&nbsp;Raul Mendoza-Ayala ,&nbsp;Jeffrey Zhang ,&nbsp;Kenneth Stauderman ,&nbsp;Sudarshan Hebbar","doi":"10.1016/j.tru.2025.100217","DOIUrl":"10.1016/j.tru.2025.100217","url":null,"abstract":"<div><h3>Introduction</h3><div>A phase 2 double-blinded trial (CARDEA) (<span><span>NCT04345614</span><svg><path></path></svg></span>) in patients diagnosed with COVID-19 revealed that intravenous zegocractin treatment (Auxora™) was associated with improved clinical outcomes compared to standard of care (SOC). D-dimer serum level is a biomarker of thrombosis in COVID-19, and elevated levels are directly correlated with a high risk of poor outcomes. Here, we report biomarker analyses from blood samples collected from patients in that study.</div></div><div><h3>Methods</h3><div>Quantification of D-dimer levels was the primary endpoint of the study. Secondary endpoints measured levels of angiopoietin 1 (Ang1), angiopoietin 2 (Ang2), soluble CD25 (sCD25), and renin. CARDEA was conducted in 17 U S. clinical centers. Patients were randomly assigned to receive Auxora plus SOC (n = 143) or placebo plus SOC (n = 141). The medications were administered by a 4-h intravenous infusion at 2.0 mg/kg (1.25 mL/kg) at 0-h and 1.6 mg/kg (1 mL/kg) at 24 h and 48 h.</div></div><div><h3>Findings</h3><div>Patients in the Auxora group had a baseline mean D-dimer value of 2.61 mg/L and those in the placebo group had a value of 2.05 mg/L. Treatment with Auxora resulted in a statistically significant decrease in D-dimer levels within the first 72 h compared to placebo (delta = −0.92; [95 % CI: −1.82, −0.02]; <em>p</em> &lt; 0.046). The decrease in D-dimer levels correlated with an increase in imputed PaO₂/FiO₂ at 72 h (r: −0.193; <em>p</em> &lt; 0.05) and improved clinical status at 168 h (r: 0.218, <em>p</em> &lt; 0.01). Auxora treatment reduced levels of Ang2 and sCD25, and increased Ang1 levels compared to placebo.</div></div><div><h3>Conclusion</h3><div>Auxora treatment significantly reduced D-dimer levels in patients diagnosed with COVID-19, and the decrease was associated with an improved clinical status.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100217"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing anticoagulation reversal practices in Colombia: Initial insights from a national registry","authors":"Sebastián Seni-Molina ,&nbsp;Santiago Posso Marín ,&nbsp;Juan Esteban Masmela ,&nbsp;María Camila Naranjo-Ramírez ,&nbsp;Arturo D. Mora ,&nbsp;Juliana María Gutiérrez-Posso ,&nbsp;Julio Diez-Sepúlveda ,&nbsp;Juan David Victoria-Salcedo ,&nbsp;Ana Cristina Montenegro Arenas ,&nbsp;Camilo Andrés Rueda Ortiz ,&nbsp;Edgar David Gómez Lahitton ,&nbsp;Hoover O. León-Giraldo ,&nbsp;Juan Esteban Gómez-Mesa ,&nbsp;On behalf of the RECCANT-AR Research Group","doi":"10.1016/j.tru.2025.100215","DOIUrl":"10.1016/j.tru.2025.100215","url":null,"abstract":"<div><h3>Background</h3><div>Anticoagulation reversal is critical in emergency settings for patients experiencing anticoagulant-related bleeding or requiring invasive or surgical procedures. Despite its importance, evidence in Colombia is limited.</div></div><div><h3>Methods</h3><div>RECCANT-AR (<strong><em>Re</em></strong><em>gistro</em> <strong><em>C</em></strong><em>olombiano de</em> <strong><em>C</em></strong><em>línicas de</em> <strong><em>Ant</em></strong><em>icoagulación y el Uso de</em> <strong><em>A</em></strong><em>gentes</em> <strong><em>R</em></strong><em>eversores</em>) is a multicenter, observational, ambispective study analyzing anticoagulated patients requiring reversal therapy due to bleeding or procedural needs. Data from the first 144 patients across four institutions were analyzed to describe their sociodemographic and clinical profiles.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 66.9 years (SD ± 15.3) and a nearly equal sex distribution. Ethnicity was predominantly Mestizo (67.5%), followed by White (17.5%) and Afrodescendant (13.3%). The most common comorbidities were hypertension (61.8%), previous venous thromboembolism episodes (31.3%), dyslipidemia (30.6%), and diabetes mellitus (21.5%). Warfarin was the predominant anticoagulant (84%), followed by apixaban (4.9%) and dabigatran (4.2%). Bleeding was the primary indication for reversal (92.4%), while surgical needs accounted for 7.6% of cases. The most used reversal agents were vitamin K (75%) and prothrombin complex concentrates (27.1%). Hospitalization was required in 82% of cases, with 55.1% admitted to intensive care. The mortality rate was 7.6%.</div></div><div><h3>Conclusion</h3><div>Our study is the first multicenter characterization of anticoagulated patients requiring reversal therapy in Colombia. Cardiovascular comorbidities were highly prevalent, highlighting their association with hemorrhagic complications. Bleeding was the leading indication for reversal, and warfarin the most used anticoagulant, likely reflecting its higher bleeding risk. The limited availability of direct oral anticoagulant-specific reversal agents remains a challenge. The high hospitalization and mortality rates underscore the high-risk nature of this population, emphasizing the need for improved access to reversal agents and optimized anticoagulation practices. Further research is warranted.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100215"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous and arterial thromboembolism in out-patients with inflammatory bowel disease: a single center study","authors":"Antonella Tufano ,&nbsp;Anna Testa ,&nbsp;Marta Patturelli,&nbsp;Antonio Rispo,&nbsp;Vincenzo Fotticchia,&nbsp;Paola Rufolo,&nbsp;Federica Strano,&nbsp;Alessia Dalila Guarino,&nbsp;Antonietta Vitale,&nbsp;Olga Maria Nardone,&nbsp;Mario Ferrante,&nbsp;Rossella Caso,&nbsp;Fabiana Castiglione","doi":"10.1016/j.tru.2025.100212","DOIUrl":"10.1016/j.tru.2025.100212","url":null,"abstract":"<div><h3>Background</h3><div>Patients affected by inflammatory bowel diseases (IBD), namely Crohn's disease (CD) and ulcerative colitis (UC), are at risk for thromboembolic events (TE). Patients with active/relapsing disease and those needing hospitalization and surgery show the highest risk. The thrombotic risk in out-patients with IBD is underestimated and poorly investigated.</div></div><div><h3>Objectives</h3><div>to evaluate the prevalence, clinical features and risk factors for thromboembolism in IBD out-patients.</div></div><div><h3>Methods</h3><div>From May 2021 to September 2023, consecutive IBD out-patients were evaluated for the presence of cardiovascular risk factors (smoking, arterial hypertension, diabetes mellitus, hypercholesterolemia) and history of TE. Patients with a history of TE (including coronary heart disease, stroke, transient ischemic attack- TIA-, deep vein thrombosis- DVT-, superficial vein thrombosis- SVT-, pulmonary embolism- PE-) were studied for thrombophilia.</div></div><div><h3>Results</h3><div>A total of 302 IBD outpatients were included in the study (154 CD; 148 UC; mean age: 41.23 ± 17.4 years). Twenty-three patients (23/302; 7.6 %) showed a thrombotic event: 14 UC patients (14/148; 9.4 %) and 9 CD patients (9/154; 5.8 %).</div><div>Among the 23 patients with TE, we observed 12 arterial thromboses (12/23; 52.2 %), including 7 cases of Myocardial Infarction (7/12; 58.3 %), 3 Ischemic Stroke (3/12; 25 %), 2 TIA (2/12; 16.7 %); and 11 episodes of venous thromboembolism (VTE) (11/23; 47.8 %), including 7 DVT (7/11; 63.6 %), 2 SVT (2/11; 18.2 %) and 2 PE (2/11; 18.2 %).</div><div>Among the 11 VTE patients 6 were affected by UC and 5 patients were affected by CD. 5 out of 12 arterial thrombosis patients were affected by CD and 7 patients by UC.</div><div>In the univariable analysis, several predictors showed a significant association with TE, including IBD activity (OR = 4.98, 95 % CI: 1.93–12.81), arterial hypertension (OR = 4.44, 95 % CI: 1.86–10.60), hypercholesterolemia (OR = 4.68, 95 % CI: 1.38–15.92), hematologic disease (OR = 6.55, 95 % CI: 1.13–37.85).</div><div>IBD activity (OR = 7.03, 95 % CI: 2.48–19.85), arterial hypertension (OR = 3.35, 95 % CI: 1.32–8.50), hypercholesterolemia (OR = 5.06, 95 % CI: 1.21–18.77), hematologic disease (OR = 12.58, 95 % CI: 1.87–69.87) and immune disease (OR = 19.39, 95 % CI: 1.29–289.60) were significantly correlated to TE events at multivariable analysis.</div></div><div><h3>Conclusions</h3><div>Out-patients with IBD presented a low but not negligible risk of TE, mainly correlated to the common cardiovascular risk factors described in the general population and to the presence of immunological and hematological disease. Clinicians should not underestimate thrombotic risk in these patients.</div></div>","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"20 ","pages":"Article 100212"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144711545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing end of life care in cancer Patients. Focus on antithrombotic treatment","authors":"Emmanouil S. Papadakis,&nbsp;Lucy A. Norris","doi":"10.1016/j.tru.2025.100213","DOIUrl":"10.1016/j.tru.2025.100213","url":null,"abstract":"","PeriodicalId":34401,"journal":{"name":"Thrombosis Update","volume":"19 ","pages":"Article 100213"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144297415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}